The development of community support programs nationally has been primarily through addition of new programs to an extensive existing base of CMHC traditional outpatient services. These have remained largely unaffected by CSP initiatives and do not meet the needs of persons with severe psychiatric disabilities. Yet for many such persons,access to CSP is limited to such settings. In its State Plan for CSP, the Delaware Division of Alcoholism, Drug Abuse and Mental Health (Division) has made the restructuring of its CMHCs a major objective. Through this application, the Division proposes to demonstrate the conversion of traditional CMHC clinic-based (outpatient) services to viable community support programs through the addition of case management services. A total of 500 consumers with severe functional impairments will be served by the project, 125 in each of four Division operated clinic sites located in both urban and rural communities. The evaluation component of the proposed project will be conducted with the Johns Hopkins School of Hygiene and Public Health, Center on organization and Financing of Care for the Severely Mentally III (Center). The Center and the division will evaluate the effectiveness of alternative organizational approaches to incorporating case management services within CMHC clinic-based settings in terms of both process and outcome measures including: 1) work setting, provider characteristics and job design; 2) service utilization; 3) community tenure; 4) quality of life; 5) psychiatric and functional stability; 6) employment; and 8) family burden. Urban verses rural comparisons will be made. Within group comparisons will also be conducted, comparing psychiatric hospitalization and community mental health service utilization during the 24 months preceding entry into the project with that during the 24 months following entry into the project.